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Quinnipiac University is expected to enroll students in its first medical school amid a surge in growth of new medical schools across the country to address the nation's doctor shortage. (Quinnipiac University contributed rendering)

The nation’s universities are opening more medical schools as graduate medical education transforms to address the nation’s physician shortage.

The Association of American Medical Colleges (AAMC), which represents medical schools and teaching hospitals, said there are now 18 medical schools under development, which is the “largest number” of schools in various stages of development in decades. A dozen of them have preliminary accreditation or provisional accreditation, the association said.

Once accredited this year, the school projects a 60-student inaugural first-year student class in 2013 to eventually grow to 125 students in each class for a total of 500, a university spokesman said in an interview.

Many of the schools under development are making a bigger push to educate future primary care physicians, which will be in greater need to improve the quality of medical care and lower costs by keeping patients out of the more expensive hospital setting. It’s the kind of accountable care approach being pushed by health insurance companies like Wellpoint (WLP), Humana (HUM), UnitedHealth Group (UNH) and the federal Medicare health insurance program for the elderly.

Insurers are increasingly paying doctors and hospitals if they can better coordinate patient care rather than the fee-for-service system of today that pays for more care even though it is not necessarily better.

“What’s holding people up is that it costs money to do that,” Dr. Atul Grover, AAMC’s chief public policy officer said of the effort to open a new medical school. “Institutions are looking to states and states don’t have the money. Other institutions have funded them privately and through philanthropy.”

The AAMC said the new medical schools will help address a physician shortage that is projected to rise to more than 90,000 by 2020 “with 32 million newly insured Americans entering the health care system,” AAMC president and chief executive Dr. Darrell Kirch said in a statement following the U.S. Supreme Court’s decision to uphold the Affordable Care Act.

“Medical schools have done their part, increasing enrollments during the last six years in response to these shortage projections,” Kirch said. “But the overall supply of U.S. physicians cannot expand unless Congress increases the number of federally funded residency training positions, a number that has been frozen since 1997."

For now, there are an adequate number of residency slots at U.S. teaching hospitals to meet the coming influx of medical school graduates.

But the AAMC worries that the funding may soon not be there to support residency programs for this larger number of medical school graduates in the next two to three years. The Balanced Budget Act of 1997 capped the number of available slots for residents coming out of medical school as part of the law’s reduction in spending on Medicare, which largely funds residency programs.

“There are real concerns among educators about the adequacy of residency slots,” AAMC’s Grover said. “Are we going to have enough slots? We feel we have done our part and now Medicare needs to do its part.”